Allen Frances MD is Professor Emeritus of Psychiatry and former Chair at Duke University

Why Are So Many College and High School Kids Abusing Adderall

During the past 15 years, there has been a remarkable transformation in the drug trade. It used to be dominated by the illegal drug cartels. Now it it is dominated by the legal drug companies.

11/09/2015 06:44 pm ETUpdated
Nov 09, 2016

During the past 15 years, there has been a remarkable transformation in the drug trade. It used to be dominated by the illegal drug cartels. Now it it is dominated by the legal drug companies.

The most dangerous legal drugs are the prescription opioids, now responsible for twice as many deaths as street drugs and also for a secondary epidemic of heroin addiction.

The next most dangerous legal drugs are Xanax and other short acting benzodiazepines that potentiate overdoses, cause severe addiction, raise the risk of falls, and worsen cognitive problems.

ADHD meds are the most dangerous legal drugs among young people in college and high school.

I have invited Dr Gretchen LeFever Watson, a clinical psychologist and public health researcher, to describe this growing problem. gwatsonphd@gmail.com
Dr Watson writes:

College students are using and abusing Adderall -- the drug commonly used to treat attention-deficit/hyperactivity disorder (ADHD) -- in record numbers. Adderall may not yet be in the water supply, but it's part of the fabric of life on modern American college campuses.

Adderall and other stimulant drugs used to treat ADHD are now so prevalent on college campuses that students misperceive them as relative benign substances. They are selling, swapping, sharing, and stealing Adderall for a host of nonmedical reasons, including "pulling all-nighters," weight loss, and partying. As a result, the number of emergency room visits and deaths associated with non-medical use of ADHD medications recently doubled.

Since the 1970s, the number of children diagnosed and medicated for ADHD has been on the rise. At last count, 14 percent of American children are diagnosed with ADHD before the end of childhood. Children diagnosed during the childhood years have been growing up and showing up on college campuses with Adderall in hand.

In the case of ADHD, the average number of children diagnosed with the condition doesn't tell the whole story. White boys are much more likely to be diagnosed than any other groups of children. And rates of diagnosis vary tremendously across states from a low of about 6% in Nevada to a high of 16% in North Carolina. The variability is even more dramatic within states, such that in the countless "ADHD hot spots" exist. In some communities -- like Virginia Beach and the surrounding area -- up to one-third or more of white boys may be diagnosed and medicated for ADHD before they graduate from high school.

Depending on where a college is located or from where it draws students, a large portion of the student body will arrive on campus with drugs in tow. By the time a cohort students graduates, more students will have been diagnosed and prescribed ADHD medications -- sometimes by college clinicians; sometimes by professionals in the surrounding community. It doesn't take students long to learn what doctor to visit and what to say to get their ticket punched for a prescription for legal, insurance-subsidized access to Adderall. Even if a student doesn't care to use the medication personally, its resale value is high. In an afternoon, the sale of a bottle of Adderall pills can easily line a student's pocket with $300 dollars.

Adderall and other stimulant medications like Concerta, Focalin, Vyvanse, and Ritalin have a high addictive potential. As long ago as 1995, the Food and Drug Administration warned that the ADHD literature prepared for the public fails to address the reality that these medications are potentially dangerous and should be used "sparingly." To this day, many professionals, parents, and students underestimate the power of these drugs because of "successful" marketing campaigns.

Many college campuses have been hosting talks by professionals affiliated with CHADD -- a leading ADHD advocacy group that is funded by the pharmaceutical industry to the tune of $1 million a year. These events typically begin by showing a movie, called ADD and Loving It?! A 2013 New York Times cover -- Drowned in a Stream of Prescriptions -- described one such event at a community college in Virginia. During the post-movie discussion facilitated by psychologist Jeffrey Katz, Psy.D., Katz told the audience that there wasn't much reason to be concerned about people using ADHD medications who do not actually have the disorder.

Katz is from Virginia Beach -- a well-documented "ADHD hot spot." When research reported high rates of ADHD diagnosis and treatment in the Virginia Beach area, Katz repeatedly spoke out in protest that the numbers were misleading or frightening people from seeking necessary care. While his concerns were not corroborated by scientific evidence and he published no research of his own, Katz had been selected to serve on the national board of CHADD and Chair of its Public Policy Committee -- a position that he held at the time of the talk.

Undoubtedly, the school administrator who approved this campus-based discussion of ADHD had no idea that it might serve as a venue for convincing college students to stay on their medications or to consider getting a prescription if they didn't already have one. A similar scenario might have played out in a talk by CHADD-friendly psychiatrist Ned Hallowell last week at the University of Washington in Seattle -- another "ADHD hot spot."

It's impossible to know which students will abuse or become addicted to 'legal speed.' Over time, use and abuse of these drugs can induce violent and aggressive behavior, anxiety and paranoia, even hallucinations and delusions. Some students experience an emotional numbing or incoherence. Withdrawal can lead to a depressed mood, fatigue, short-term memory loss, inability to concentrate, and psychomotor agitation or lethargy. This is why they are classified as one of the most addictive types of prescription medications available today and should be, but aren't, prescribed sparingly.

Thanks, Dr Watson. The epidemic of mislabeled ADHD has medicalized childhood, turning normal immaturity into a mental disorder. The excessive use of ADHD medication has been fueled by irresponsible drug company marketing; careless physician diagnosing and prescribing; worried parents; and harried teachers.

We need to stop overdiagnosing and overmedicating "ADHD," in order to reduce the massive reservoir of legally prescribed pills available for diversion to the secondary illegal market.

And we need to educate students and educators that using Adderall for recreation or performance enhancement has considerable risks and is not a normal part of life.

We are fighting the wrong war on drugs -- battling drug cartels that history shows we can't beat, while ignoring the even more destructive effects of a drug industry we can easily control.